The Clinical Significance Of Serum Procalcitonin Level In Children With Severe Pneumonia

Community-acquired pneumonia(CAP) is not only the commonest diseases but also the common cause of death in children. The incidence of pneumonia is significantly higher in children under 5 years old. The younger, the incidence of CAP is higher. Besides, the incidence of CAP is higher in city. Retrospective analysis of the literature between 1985-2008 found that pneumonia in the mortality in children under 5 years old was about 180-1200 per million people.City was higher than country. Now with the increasing environment pollution, the prevalence of CAP is increasing year by year.Because of imperfect development of the respiratory system, hypoimmunity, improper feeding etc, children, especially babies, are prone to severe pneumonia. As children CAP changes fast, children severe pneumonia always complicates pleural suffusion,heart failure, respiratory failure and so on. These reasons contribute to the high mortality of children CAP. Early diagnosis and effective treatment can reduce the mortality of severe CAP. Except the clinical manifestations, serum biomarkers can also be an objective basis.White Blood Cell(WBC) is a common inflammatory marker in infectious diseases. It facilitates the clinical diagnosis and treatment in a way. But the leucocyte count is influenced by many factors. Its sensitivity and specificity has great limitations when it is used on diagnosis.C-reactive protein(CRP) is an acute stress proteins synthesized by liver. It is related to the inflammation directly, the damage degree of the tissue. When the body is under acute reaction, CRP arises early and keeps increasing with persistent inflammation. But it arises in non-infectious diseases too, so it makes it difficult to distinguish the nature of the disease.Procalcitonin(PCT) is a new biomarker and plays an increasingly important role in infection diseases. Most of the studies show that the specificity and sensitivity of PCT were higher than the WBC and CRP. PCT is widespread used in various clinical areas. It has great meanings in early diagnosis and treatment of severe pneumonia in adults, but we can find little research in children with severe CAP. As a result, We plan to study the clinical significance of WBC, CRP and PCT in children with severe pneumonia.Objective:1 To study severe CAP in children, analysis the clinical significance of WBC, CRP, PCT.2 To dynamically monitor the change of WBC, CRP, PCT in order to find clinical significance of these biomarkers in the prognosis of severe CAP.3 To discuss the importance of PCT in the process of diagnosis and treatment of severe CAP.Methods:1 Patients: We studied all children hospitalized with community acquired pneumonia(CAP) in Pediatrics apartment for Jan, 2014 to Dec, 2014. 50 are severe cases(22 male, 28 female, mean age 0.92±0.44 months). Control group includes 50 cases of mild pneumonia(26 male, 24 female, mean age 0.86±0.60 months).2 Inclusion Criteria: 1). The diagnosis of Severe CAP was based on Guidelines for the Management of CAP in Children updated in 2013; 2). Elder than 28 days at admission; 3). Under 5 years old at admission; 4). Got the informed consent of patients’ parents.3 Exclusion Criteria: 1). With history of asthma, chronic cough and recurrent respiratory tract infection; 2). With other disease; 3). With anemia, rickets and low immunity; 4). With congenital diseases like heart disease, hypothyroidism, etc.; 5). With drug allergy; 6). With cerebral palsy or central coordination disturbance; 7). With genetic disease or metabolic diseases.4 Research approach: Control group had blood tested at 1st day. Subject group had blood test at 1st, 3rd, 5th day. Pathogen exam: All patients had sputum culture at 1st day and pathogen antibody identified at 7th day.5 Statistics: Age, gender, serum WBC, CRP, PCT, pathogen and pathogen antibody are analyzed.6 Analysis: We use SPSS 13.0 to analyze the collected data. Two sample were compared with t test. For continuous variable we use ANOVA. Measurement data are showed as mean±SD. Count data are showed as cases and percentage. P < 0.05 as statistically significance, P < 0.01 as highly statistically significance.Results:1 Subject group includes 50 cases of severe CAP(22male, 28 female, mean age 0.92±0.44 months). 22 cases(44%) are bacterial pneumonia(staphylococcus aureus, Streptococcus pneumoniae, klebsiella, escherichia coli). 10 cases(20%) are mycoplasma pneumonia. 6 cases(12%) are viral pneumonia(Adenovirus or respiratory syncytial virus). In 12 cases(24%) the pathogen are unknown. 25 cases(50%) are complicated with heart failure. 32 cases(64%) are complicated with respiratory failure. 18 cases(36%) are complicated with pleural effusion. 2 cases(4%) are complicated with shock. 1 cases(2%) are complicated with toxic enteroparalysis. 1 cases(2%) are complicated with toxic encephalopathy. Control group includes 50 cases of mild CAP(26 male, 24 female, mean age 0.86±0.60 months). 8 cases(16%) are bacterial pneumonia. 12 cases(24%) are mycoplasma pneumonia. 5 cases(10%)are viral pneumonia(Adenovirus or respiratory syncytial virus). In 25 cases(50%) the pathogen are unknown.2 Before treatment, the CRP and PCT level in control group was slightly elevated, and WBC level was not highly elevated. The CRP, PCT and WBC level in severe CAP group were higher than control group(P<0.01).3 In severe CAP group, WBC level dropped after treatment(P<0.05) and CRP, PCT lever dropped remarkably(P<0.01). PCT level dropped faster than WBC and CRP.Conclusions:1 The increase of WBC, CRP and PCT levels can reflect severity of disease. Compare with WBC and CRP, PCT is more sensitive and specific.2 The WBC, CRP and PCT levels decrease after effective treatment in the case group. Compared with the WBC and CRP, PCT level decreases earlier and has better estimation on the prognosis of the diseases. 4PCT is more sensitive to estimate the severity and the prognosis of community-acquired pneumonia in children.